Adhesions in this small suboccipital triangle of deep posterior cervical muscles, are one of the most common causes of tension headaches.
Deep Posterior Cervicals
Deep Posterior Cervical Structures
- Semispinalis capitis & cervicis
- Longissimus capitis & cervicis
- Multifidi; Rotatores; Transversospinalis
- Nuchal Ligament - CT that runs from the external occipital protuberance to sp of C-7; helps to stabilize the head and neck; attachment sight of the trapezius and splenius capitis
- Covered by the nuchal fascia
- Same side rotator
- bilaterally extends head and neck
- Capitis forms a “V” shape inserting on the mastoid process and occipital bone (deep to the SCM).
- Same side rotator; bilaterally extends head and neck
- Insertion C1,2,3 tvp’s
- Origin T3-T6 spinous process
- Primary TP’s referral is pain in the angle of the neck, head and eye.
Pain is often reported to seem to shoot through the head to the back of the eye or a band around the side of head leading to the eye.
Tp’s can also be a cause of stiff neck, which limits same side rotation, along with the levator scapula.
Suboccipital Triangle-Headache muscles
- Rectus capitis minor
- Rectus capitis major
- Oblique capitis superior
- Oblique capitis inferior
These small muscles form the deepest layer of the upper posterior neck. They are involved in stabilizing the Axis (C-2) and the
Atlas (C-1); and in creating intrinsic movements such as rocking and tilting of the head. To outline the suboccipitals’ location, find the spinous process of C-2, the transverse processes of C-1 and the space between the superior nuchal line of the occiput and C-2.
Active TP’s often cause referred pain deep in the head that radiates from the occiput, across the temple, towards the orbit.
Whether addressing stubborn neck pain, postural issues, or cold whiplash, working the deepest structures in the neck will often yield results that nothing else can.
Proprioception - “New felt sense of the body in space”
- The goal is to shift the person's perception of their body in space, so they can change their posture and dysfunctional mov’t pattern.
Nod Test: assessment of 3 important things
- Freedom at the atlanto-occipital (A/O) joint.
- The ability of the posterior compartment of the neck to lengthen.
- The degree of participation of the “prevertebral” muscles along the front of the neck.
Small Nod Procedure:
- Looking at your clients profile, ask for small nodding motions. We want just a little bit of mov’t - too much will make the initiation of mov’t hard to see.
- Watch to determine which neck joint moves first and which joint/s are not flexing and extending?
- When the soft tissue structures around the A/O are free, small nodding motions will primarily happen here, allowing the head to balance and rock on the atlas like a seesaw.
- If the motion appears to be happening lower in the neck, instead of at the A/O, it indicate restrictions in the suboccipital or transversospinalis myofascia.
- Large Nod; as in looking up and down
- Look for the ability of the posterior compartment of the neck to lengthen in flexion.
- Fascial wrapping around nuchal ligament can restrain cervical flexion.
- When the tissues can lengthen, the nodding happens primarily at the top of the neck.
- When they are tight and can’t lengthen, cervical flexion is limited, and the motion of nodding results in the entire neck to move as a unit, instead of flexing and opening up at each facet joint.
- Neck inclines as a solid unit.
Posterior Cervical Compartment Technique
- Side Lying
- Working the longitudinal structures of the posterior cervical compartment.
- Splenius, upper trapezius, nuchal ligament and the deeper transversospinalis group.
- Stand on the side opposite to the treatment side. This enables you to work across the muscle fibers more efficiently.
- Place the head in a neutral supported position.
- Using a braced finger, apply transverse friction massage starting at the occiput (suboccipitals) and work incrementally down towards C-7, treating the cervical erector spinae
- Finish by stripping through the entire cervical erector group with your thumb. in a superior direction to elongate the tissues.
2: Supine Erector Spinae Stripping
- If possible, slightly extend the head rest on your table and place your hands under the head.
- Treat one side at a time from about C-7 to occiput.
- Strip up and in to the musculature using your index or middle finger.
- Your intention is to go up and into the erector spinae tissues.
- Stay in the lamina groove right along the spine on either side (picture X-country ski tracks).
- Stretch the posterior extensors of the neck by passively flexing the neck to a comfortable end range.
3. Deep Cervical Rotators:
Splenius Cervicis, Semispinalis Cervicis, Oblique capitis inferior.
- Passively extend and rotate the head slightly, to more easily palpate through the overlying erector and trapezius fibers. These fibers will not be particularly distinct, however, the density can be felt in the lamina groove.
- Cradle the head with one hand while the other hand locates the lamina groove of the upper cervical vertebrae. Your intention is to sink into the tissues by directing your palpation towards the spinous process in the lamina groove.
- With the thumb pad of the treatment hand palpating the tissues, slowly lower the head into extension, letting it rest against the “post” provided by your thumb.
- Control the treatment depth, by adjusting the amount of head weight you support with your non-treatment hand.
- Move the head slowly from this extended position, back to neutral, and back to extension again. You can also add slight rotation.
- This allows you to apply pressure intermittently.
- Your intention should be to sink into these deep tissues by moving upwards into the lamina groove.
- This technique can be quite intense and cause local and referred pain – use caution and increase treatment depth gradually.
- This deep tissue technique is only possible if the patient can relax and give you control of their head. You must establish trust with your patient before attempting this maneuver.
1. Suboccipitals: Tension Headaches
Adhesions in this small triangle of deep posterior cervical muscles, are one of the most common causes of tension headaches.
2. Sternocleidomastoid (SCM)
SCM trigger points can cause referred pain into the face, ear, above the eyes and to the occipital region.
3. Longus Colli and Capitus
These deep neck flexors attach from the anterior surface of the cervical vertebrae to the occiput and atlas.
4. Upper Trapezius: Tension Headaches
Upper trapezius trigger points refer pain along the posterolateral aspect of the neck, behind the ear and to the temple.
5. Side Lying Neck Release
The side-lying position opens up the entire angle of the neck, and the client is often more relaxed and able to keep their muscles passive.
6. Thoracic Outlet Syndrome/Scalenes
Thoracic outlet syndrome is actually a collection of syndromes brought about by abnormal compression of the neurovascular bundle by bony, li...
7. Scalenes in Side Lying
The scalenes are sandwiched between the SCM and the anterior flap of the upper trapezius and levator scapulae, and can be accessed very effe...
8. Prone Upper Back Release
Techniques for the parascapular muscles, upper trapezius and levator scapulae.
9. Pectoralis Minor – Thoracic Outlet Syndrome
The major vessels serving the arm – the brachial plexus, axillary artery and vein – cross underneath the pectoralis minor, creating the pote...
10. First Rib Release
The first rib can be a source of pain and dysfunction when it becomes fixated, and is often associated with C7-T1 dysfunction.
11. Active Release Techniques for Upper Back
Active release ('anchor and stretch'), involves a process in which the client is instructed to actively move in a specific pattern to their ...